obsolete acute pyelonephritis with lesion of renal medullary necrosis

Obsolete Acute Pyelonephritis with Renal Medullary Necrosis

Acute pyelonephritis is a type of kidney infection that was previously known as "acute pyelitis" or "pyelonephritis with medullary necrosis". This condition was characterized by inflammation and damage to the renal medulla, which is the innermost part of the kidney responsible for filtering waste from the blood.

Causes and Risk Factors

The exact causes of obsolete acute pyelonephritis with renal medullary necrosis are not well understood. However, it is believed that this condition was often associated with bacterial infections, particularly those caused by gram-negative bacteria such as E. coli [3]. Other risk factors may have included underlying structural abnormalities in the kidneys, urinary tract obstruction, or weakened immune systems.

Symptoms and Diagnosis

The symptoms of obsolete acute pyelonephritis with renal medullary necrosis were likely similar to those of modern-day acute pyelonephritis, including fever, flank pain, and hematuria (blood in the urine). However, the exact presentation may have varied depending on the individual case.

Treatment and Prognosis

The treatment for obsolete acute pyelonephritis with renal medullary necrosis was likely similar to that of modern-day acute pyelonephritis, involving antibiotics and supportive care. However, the prognosis for this condition is not well documented in historical medical literature.

References

• [1] Renal papillary necrosis is an uncommon severe complication of pyelonephritis (2–5%) that occurs most often with underlying structural renal abnormalities or ...
• [3] Definition: A bacterial infection, typically ascending, of the renal pelvis (pyelitis) or pelvis and renal parenchyma (pyelonephritis). Introduction: One of the ...
• [4] Morphologic Diagnosis: Kidneys, bilateral, medulla and crest, necrosis, focally extensive, subacute, severe, with tubular erythrocyte casts and epithelial ...

Note: The term "obsolete" is used to describe this condition as it was likely replaced by more modern terminology for acute pyelonephritis.

Obsolete Acute Pyelonephritis with Renal Medullary Necrosis: Signs and Symptoms

Acute pyelonephritis is a type of kidney infection that can cause severe symptoms. However, the term "obsolete" suggests that this condition may no longer be commonly encountered or recognized in modern medical practice.

Clinical Presentation

The clinical signs and symptoms of acute pyelonephritis with renal medullary necrosis are similar to those of other types of kidney infections. These include:

• Fever: A high temperature, often accompanied by chills [2].
• Flank or abdominal pain: Pain in the area over the affected kidney, which may be severe and radiate to the lower back [3, 5, 7].
• Dysuria: Difficulty or pain while urinating [9].
• Frequent urination: Needing to urinate more often than usual, often accompanied by a sudden, strong urge to urinate [2].
• Nocturia: Waking up multiple times at night to urinate [3].

Additional Symptoms

In some cases, patients may also experience:

• Nausea and vomiting: Feeling queasy or vomiting due to the infection [5].
• Oliguria: Producing less urine than usual [6].
• Pyuria: Having a high amount of white blood cells in the urine, indicating an infection [3].

Important Note

It's worth noting that the term "obsolete" suggests that this condition may no longer be commonly encountered or recognized in modern medical practice. However, based on the search results provided, it appears that acute pyelonephritis with renal medullary necrosis was once a recognized condition.

References:

[1] Not applicable (since the context does not mention "obsolete" as a characteristic of the condition)

[2] Context result 2: Fever and chills · Painful urination. Painful urination · Needing to urinate more often than usual (frequent urination) or a sudden, strong urge ...

[3] Context result 3: Nocturia, frequent urination at night. Pyuria, unusually high amount of white blood cells in urine. Severe flank pain on either side of your back.

[4] Not applicable (since the context does not mention "obsolete" as a characteristic of the condition)

[5] Context result 5: Patients typically present with fever, chills, and flank or abdominal pain. Two-thirds of patients have nausea and vomiting, and dysuria may not be present.

[6] Context result 6: The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases.

[7] Context result 7: The area over the affected kidney (in the flank) may feel tender during an exam. There may be a history of urinary tract infections. There may be signs of ...

[8] Not applicable (since the context does not mention "obsolete" as a characteristic of the condition)

[9] Context result 9: Symptoms include fever, loin (kidney) pain, nausea and vomiting. Co-incident symptoms of acute cystitis with dysuria, frequency and haematuria may occur.

Based on the search results, it appears that there are several diagnostic tests that can be used to diagnose acute pyelonephritis (APN) and renal medullary necrosis. Here are some of the relevant findings:

• Imaging studies: Abdominal ultrasound or intravenous pyelography may help confirm the diagnosis of APN, while magnetic resonance imaging (MRI) can detect kidney infection or masses and urinary obstruction, and evaluate the kidney vasculature [2].
• Computed Tomography (CT) scans: CT scans can also be used to accurately diagnose renal papillary necrosis, which is a type of damage that occurs in the kidneys and can lead to kidney failure [11]. Historically, subsequent verification via IVU was required.
• Laboratory tests: Urine test; Blood tests; Ultrasound, CT, or other imaging tests of the kidneys are used for diagnosis [9].
• Kidney biopsy: The definitive diagnosis of Acute Interstitial Nephritis (AIN) requires a kidney biopsy, as well as laboratory or clinical identification of the causative factor [8].

It's worth noting that the diagnosis of APN is based on a combination of clinical, laboratory and sonographic findings [6]. One major limitation in reviewing the literature is the lack of standardization in diagnostic criteria.

In terms of obsolete tests, it appears that IVU (Intravenous Pyelography) was historically used to verify renal papillary necrosis after CT scans were performed. However, this test is no longer commonly used today due to advances in imaging technology.

References:

[2] - Magnetic resonance imaging (MRI) can detect kidney infection or masses and urinary obstruction, and it can evaluate the kidney vasculature. [6] - The diagnosis of pyelonephritis is based on a combination of clinical, laboratory and sonographic findings. [8] - Prevalence. The definitive diagnosis of AIN requires a kidney biopsy, as well as laboratory or clinical identification of the causative factor. [9] - Urine test; Blood tests; Ultrasound, CT, or other imaging tests of the kidneys. [11] - CT scans can also be used to accurately diagnose renal papillary necrosis. Historically, subsequent verification via IV

Treatment of Obsolete Acute Pyelonephritis with Renal Medullary Necrosis

The treatment of obsolete acute pyelonephritis with renal medullary necrosis is a complex process that requires immediate attention. According to various medical sources [1, 2], patients with this condition may require broad-spectrum intravenous antibiotics, hydration, glycemic control, and urinary catheterization.

• Broad-Spectrum Antibiotics: Immediate administration of broad-spectrum antibiotics is crucial in treating acute pyelonephritis, especially when renal medullary necrosis is present [1].
• Hydration: Proper hydration is essential to prevent further kidney damage and promote the elimination of bacteria from the urinary tract [2].
• Glycemic Control: Maintaining normal blood sugar levels is also important in managing this condition, as uncontrolled diabetes can exacerbate renal medullary necrosis [3].

In some cases, percutaneous drainage may be necessary to relieve obstruction and promote healing [4]. However, the specific treatment approach depends on the underlying cause of the condition.

• Analgesic Nephropathy: If analgesic nephropathy is the cause, stopping the use of pain medications that can harm the kidneys is essential [5].
• Infection Control: In cases where infection is present, administering antibiotics and controlling the infection are crucial steps in managing this condition [6].

It's worth noting that renal papillary necrosis, a related condition, does not have a specific treatment. Instead, managing the underlying cause to limit further damage to the kidneys is essential [7].

Based on the search results, it appears that differential diagnosis for acute pyelonephritis (APN) and its variants is a complex topic.

Differential Diagnosis

The differential diagnosis for APN includes various conditions that can present with similar clinical features. Some of these conditions include:

• Acute Tubular Necrosis (ATN): ATN is a condition characterized by the death of tubular cells in the kidney, which can be caused by ischemia or toxins. It can present with similar symptoms to APN, such as acute kidney injury and pyuria [4].
• Renal Papillary Necrosis (RPN): RPN is a condition where the renal papillae become necrotic, leading to damage to the renal medulla. It can be caused by various factors, including diabetes mellitus, analgesic abuse, and chronic kidney disease [8][9].
• Emphysematous Pyelonephritis (EPN): EPN is a rare but severe form of APN that is characterized by gas formation in the renal parenchyma. It can be caused by various factors, including diabetes mellitus and urinary tract obstruction [13].

Lesions of Renal Medullary Necrosis

The search results suggest that lesions of renal medullary necrosis are a feature of RPN. These lesions can cause damage to the renal medulla and lead to reduced kidney function and potentially kidney failure [8][9].

Differential Diagnosis with Lesion of Renal Medullary Necrosis

In cases where APN is suspected, but there are lesions of renal medullary necrosis, the differential diagnosis should include RPN. This condition can be differentiated from APN by the presence of specific radiographic findings, such as a dilated calyceal fornix and retracted or irregular papillary tip [3].

References

[3] - Refers to search result 3, which mentions that early renal papillary necrosis includes a dilated calyceal fornix, retracted or irregular papillary tip, and extension of contrast material into the medulla.

[8] - Refers to search result 8, which states that in renal papillary necrosis, the middle part of your kidneys becomes damaged, leading to reduced kidney function and potentially kidney failure.

[9] - Refers to search result 9, which describes the two forms of RPN (medullary and papillary) and their differential diagnosis from APN.